I have always been uncomfortable with the readiness to “medicalise” all behavioural issues. Where parents or teachers or social workers and others charged with teaching behavioural skills can easily find an excuse for their failures. Because a behavioural problem has been classified as a medical problem. Nearly always leading to the use of medication. There seems to be an unholy alliance between the psychiatry industry and the pharmaceutical industry.
The Psychiatry Bible (DSM 5) has seemed to me to be nothing but a Marketing Brochure for the pharmaceutical companies where
The drug companies pay eminent professors, university officials and teaching hospital chairmen millions ‘in personal income’ to concoct more and more abnormalities so that more and more pills can be dished out by GPs and specialists.
They pocket consultancy fees to attend conferences, give marketing lectures and endorse useless tablets. They are bribed, in essence, not to openly criticise the pharmaceutical industry.
.. people are led to believe they have ‘a problem in their brain’ if they drink too much coffee (‘caffeine-related disorders’), stutter or swear (‘language disorders’), are shy or reserved (‘social phobias’), suffer period pains, are too fat or too thin, feel irritable, sexy, unsexy, sleepless, tired, or experience grief for more than two weeks after the death of a loved one. By these means, 26.2 per cent of all American adults suffer from a disorder of some sort, requiring that it be ‘pharmacologically treated’. Though psychiatric research is by all accounts ‘a hodgepodge, scattered, inconsistent and ambiguous’, one thing has definitely emerged – that anti-depressants don’t work. Extensive trials have shown that placebos induce as much of a degree of uplift as Prozac, Seroxet or any of the other wonder drugs, which simply make patients feel numb, glassy and emotionally disengaged.
Now it seems Dyslexia does not really exist.
Now comes The Dyslexia Debate, published yesterday, a rigorous study of this alleged ailment by two distinguished academics – Professor Julian Elliott of Durham University, and Professor Elena Grigorenko of Yale University.
Their book makes several points. There is no clear definition of what ‘dyslexia’ is. There is no objective diagnosis of it. Nobody can agree on how many people suffer from it. The widespread belief that it is linked with high intelligence does not stand up to analysis.
And, as Parliament’s Select Committee on Science and Technology said in 2009: ‘There is no convincing evidence that if a child with dyslexia is not labelled as dyslexic, but receives full support for his or her reading difficulty, that the child will do any worse than a child who is labelled dyslexic and then receives special help.’
This is because both are given exactly the same treatment. But as the book’s authors say: ‘Being labelled dyslexic can be perceived as desirable for many reasons.’ These include extra resources and extra time in exams. And then there’s the hope that it will ‘reduce the shame and embarrassment that are often the consequence of literacy difficulties. It may help exculpate the child, parents and teachers from any perceived sense of responsibility’.
I think that last point is the decisive one and the reason for the beetroot-faced fury that greets any critic of ‘dyslexia’ (and will probably greet this book and article). If it’s really a disease, it’s nobody’s fault. But it is somebody’s fault. For the book also describes the furious resistance, among teachers, to proven methods of teaching children to read. Such methods have been advocated by experts since Rudolf Flesch wrote his devastating book Why Johnny Can’t Read almost 60 years ago.
It was not so long ago that James Davies addressed the ills of Psychiatry in his book “Cracked: Why Psychiatry is Doing More Harm Than Good” and Richard Saul published his book “ADHD Does Not Exist” criticising the over-diagnosis of ADHD. Richard Saul writes in the New Republic:
The stimulants most often prescribed for ADHD represent several different types of agents that help control attention and behavior. These include methylphenidate (like Ritalin and Concerta) and mixed salt amphetamines (like Adderall and Vyvanse). Each of these has a specific effect on the body’s neurotransmitters, or the chemical compounds that help transmit signals within the nervous system. The exact mechanisms by which these chemicals interact are very complex, but essentially, if levels of these chemicals are too low or their activity is blocked, the transmission of messages within the nervous system decreases, corresponding to a state of inattention or impulsivity. Specific medications aimed at targeting attention-deficit and hyperactivity symptoms help increase levels of neurotransmitters and their activity. For example, methylphenidate-based medications like Ritalin increase the activity of the neurotransmitters dopamine and noradrenaline in the parts of the brain that help to control attention and behavior. Adderall also increases dopamine’s effects, but in a more gradual way than Ritalin and similar agents do.
So let’s back up a moment. If stimulants can increase one’s attention span and reduce impulsivity, why shouldn’t we use them? Furthermore, even if we’re masking another underlying condition, aren’t we at least solving the problems of inattention and impulsivity in the patient? The answer to both of these questions is a resounding NO. While stimulants can help people with a variety of symptoms in the short term, they have multiple damaging effects in the short- and long-term. The most common short-term side effects associated with stimulants involve overstimulation, such as loss of appetite and sleep disturbance, but perhaps more troubling are the longer-term effects of stimulant use, which include unhealthy weight loss, poor concentration and memory, and even reduced life expectancy in some cases. Long-term, patients also face the development of tolerance, which exacerbates these side-effects. After a while, the body adjusts its natural production of these same chemicals in the brain, and the temporary improvements in attention and behavior begin to disappear. This is why we see doctors prescribing higher and higher doses of the stimulant to achieve the same effect in the patient as time wears on—a dangerous pattern.
Medicalising behavioural issues or blaming genetic causes for behavioural lapses is a cop-out. Both for the offending individual and for those who ought to be helping the individual to modify his behaviour.
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